Nomifensine (Merital, Alival) is a norepinephrine-dopamine reuptake inhibitor developed by a team at Hoechst AG in the 1960s. The drug was test marketed in the United States by Hoechst AG (now Sanofi-Aventis), i.e. a drug that increases the amount of synaptic norepinephrine and dopamine available to receptors by blocking the dopamine and norepinephrine reuptake transporters. This is a mechanism of action shared by some recreational drugs like cocaine and the medication, Tametraline(see DRI). Research showed that the (S) isomer is responsible for activity. The drug was an effective antidepressant, without sedative effects. Nomifensine did not interact significantly with alcohol and lacked anticholinergic effects. No withdrawal symptoms were seen after 6 months treatment. The drug was however considered not suitable for agitated patients as it presumably made agitation worse. In January 1986 the drug was withdraw by its manufacturers for safety reasons.
Some case reports in the 1980s suggested that there was potential for psychological dependence on nomifensine, typically in patients with a history of stimulant addiction, or when the drug was used in very high doses (400–600 mg per day).
In a 1989 study it has been investigated for use in treating adult ADHD and proven successful. In a 1977 study it has not proven of benefit in advanced parkinsonism, except for depression associated with the parkinsonism.
Due to the risk of a risk of haemolytic anaemia, the U.S. Food and Drug Administration (FDA) withdrew approval for nomifensine on March 20, 1992. Nomifensine has subsequently been withdrawn from the Canadian and UK markets as well. Some deaths were linked to immunohaemolytic anemia caused by this compound although the mechanism remained unclear.
In 2012 structure–affinity relationship data (compare SAR) were published.
^Yakabow, A. L.; Hardiman, S.; Nash, R. J. (1984). "An Overview of Side Effects and long-term Experience with Nomifensine from United States Clinical Trials". The Journal of Clinical Psychiatry45 (4 Pt 2): 96–101. PMID6370985.edit
^Shekim, W. O.; Masterson, A.; Cantwell, D. P.; Hanna, G. L.; McCracken, J. T. (1989). "Nomifensine Maleate in Adult Attention Deficit Disorder". The Journal of Nervous and Mental Disease177 (5): 296–299. doi:10.1097/00005053-198905000-00008. PMID2651559.edit
^Galbaud du Fort, G. (1988). "Hematologic toxicity of antidepressive agents" [Hematologic Toxicity of Antidepressive Agents]. L'Encephale (in French) 14 (4): 307–318. PMID3058454.edit
^Pechulis AD et al (2012): "4-Phenyl tetrahydroisoquinolines as dual norepinephrine and dopamine reuptake inhibitors", Bioorg. Med. Chem. Lett., 7219. PMID 23084899
^Zara-Kaczian, E.; Gyorgy, L.; Deak, G.; Seregi, A.; Doda, M. (1986). "Synthesis and pharmacological evaluation of some new tetrahydroisoquinoline derivatives inhibiting dopamine uptake and/or possessing a dopaminomimetic property". Journal of Medicinal Chemistry29 (7): 1189. doi:10.1021/jm00157a012.edit